ABSTRACT Over 150,000 adolescents in the United States identify as transgender or gender diverse (TGGD). TGGD youth are at high risk for mental health problems, and social support is critical for mitigating this risk. TGGD youth who are affirmed in their gender identities have similar rates of mental health concerns as the general population of adolescents. However, the affirmation and support youth receive can come from multiple places. Parental and peer support are crucial factors in affirmation of gender identity. Our preliminary data show that social media platforms are also being used by TGGD youth for social support. In particular, informational support from social media may be an important factor in gender identity exploration and knowledge of medical interventions such as hormonal treatment and surgeries. TGGD youth report following popular social media content creators, or “influencers,” on various social media platforms and finding information and inspiration from these individuals. However, the nature and factual accuracy of information found in TGGD influencer content is largely unknown. Parents of TGGD youth and the public at large have expressed concern that social media content may have undue influence on youths’ gender identity formation, leading to possible gender confusion in youth and inappropriate requests for medical intervention. However, the perspectives of TGGD youth on this topic are unknown, as are specific parental reflections on TGGD-related digital content. The overarching goal of this proposal is to examine the phenomenon of TGGD influencer content from multiple angles including objective content analysis, youth-driven qualitative inquiry, and parent-driven qualitative inquiry. The rationale for this study is that further knowledge of the nature, factual accuracy, and youth and parent perceptions of TGGD influencer content is a first step toward developing anticipatory guidance for providers and media literacy for youth who identify as TGGD and their parents. The aims are: Aim 1: Perform a content analysis of social media posts to describe the ways that popular TGGD role models, also known as influencers, discuss gender identity development and gender affirmation through medical and nonmedical means; Aim 2: Using qualitative inquiry and digital prompts, identify the perceptions of and concerns regarding TGGD influencer-created social media content among parents of TGGD youth; and Aim 3: Using qualitative inquiry and digital prompts, determine elements of TGGD influencer-created content that TGGD youth report are helpful for exploration of gender identity and gender affirmation through medical and nonmedical means. These Aims will be carried out through direct observation of social media profiles of TGGD influencers, followed by semistructured interviews with TGGD youth in which participants view and reflect on influencer content, as well as similar semistructured interviews with parents of TGGD youth.

PROJECT NARRATIVE Transgender and gender diverse youth use social media platforms, and particularly content creators or “influencers,” to find informational support regarding gender identity and health. The overarching goal of this proposal is to understand the nature of transgender and gender diverse influencer social media content and to obtain specific feedback from transgender and gender diverse youth and their parents regarding this content. This knowledge would improve the ability of health care providers and other professionals who work with youth to provide anticipatory guidance and education to youth and parents regarding social media and gender identity.